If you have any questions regarding the Patient Forms feel free to contact our office at (516)487-2444.
Patient Registration Form
Consent for Use and Disclosure of Protected Health Information
Patient Financial Responsibility Statement
Card on File Agreement
Notice of Privacy Practices
HIPAA Consent
Office Policies
Medical Procedure Billing Form
Medical Records Release Form
Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.
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North Shore Gastroenterology Associates, participates with most major insurance carriers. As a courtesy to our patients, we will file claims for those insurances with which we participate. Please note that any amount not covered by your insurance company is ultimately your responsibility. While a list of insurance companies we participate with is available on our website, it is strongly recommended that you contact your insurance company prior to your visit to confirm that we are still participating.
Payment will be requested and is required at the time of service for all services that are non‐covered or determined to be the patient’s responsibility, including co‐payments. Payment may be made by check or credit/debit card. If you have any questions regarding insurance, billing or our fees, please call our billing department.
Below is a list of Insurance Companies that North Shore Gastroenterology Associates, P.C. participates with. Please note that this may not be a complete list, and is subject to change without notice. You should contact your insurance carrier for verification of benefits.
About
Our GI Care
For Your Visit
Great Neck Office
233 East Shore Road,
Suite 101,
Great Neck, NY 11023
P: 516-487-2444
Mon – Fri: 9:00 AM – 5:00 PM
Sat & Sun: Closed
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